Medicare Advantage Payment Reform: Ending Unreasonable Coding and Diagnosis Inflation.
This bill aims to improve the accuracy of payments made to Medicare Advantage plans serving seniors. It introduces new rules for calculating patient health risk to prevent the inflation of diagnoses and unjustified increases in insurer funding. Citizens can expect greater transparency and better use of public funds allocated for healthcare.
Key points
Medicare Advantage plans must use two years of diagnostic data to more accurately assess patient health status, effective starting in 2024.
Diagnoses collected solely from chart reviews or health risk assessments will no longer count toward payment calculations for insurance plans.
The government must annually evaluate and adjust for differences in how private plans code illnesses compared to traditional Medicare to ensure fair billing.
Expired
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